The cruise director is the ship's liver because almost everything you can think of filters through them at some point.

Actor Willie Aames

October is Liver Awareness Month, the month chosen by the American Liver Foundation to raise public awareness of the importance of liver health.

As a diabetic, I see the importance, even though I'm not really sure what the old workhorse does.

Diabetes Education Online, the website of the Diabetes Teaching Center at the University of California, San Francisco states that the liver acts as the body's glucose (or fuel) reservoir and helps keep circulating blood sugar levels and other body fuels steady and constant. It stores and manufactures glucose, depending on the body's need.

The need to store or release glucose is primarily signaled by the hormones insulin and glucagon.

During a meal, the liver will store sugar or glucose as glycogen for a later time when your body needs it. When you are not eating, especially overnight or between meals, the body has to make its own sugar. The liver supplies sugar or glucose by turning glycogen into glucose in a process called glycogenolysis.

The liver can also manufacture the needed glucose by harvesting amino acids, waste products and fat byproducts. That process is gluconeogensis.

The liver also makes another fuel, ketones, when sugar is in short supply. When glycogen storage is running low, the body starts to conserve sugar supplies for organs that always require sugar. They include the brain, red blood cells and parts of the kidney. That process is called ketogenesis.

Ketones are burned as fuel by muscles and other body organs, and the sugar is saved for the organs that need it.

When you have diabetes, these bodily processes can be thrown off balance. Everything affects everything.

More and more these days I see the term fatty liver disease, but there is also nonalcoholic fatty liver disease. According to the website of the Mayo Clinic (mayoclinic.org), NAFLD is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. The main characteristic is too much fat stored in liver cells.

They say it is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting about one-quarter of the population.

Some people with nonalcoholic fatty liver disease can develop nonalcoholic steatohepatitis, an aggressive form of fatty liver disease marked by liver inflammation. It can progress to advanced scarring (cirrhosis) and liver failure. The damage is similar to the damage caused by heavy alcohol use.

There are usually no real signs or symptoms, but when any do appear, they can include fatigue, and pain or discomfort in the upper right abdomen.

Possible signs of this steatohepatitis include abdominal swelling, enlarged blood vessels just beneath the skin's surface, an enlarged spleen, red palms and yellowing of the skin and eyes.

There seems to be limited understanding of why some people accumulate fat in the liver and others do not. And there is also limited understanding of why some fatty livers develop inflammation that progresses to cirrhosis. But both conditions are linked to the following:

Overweight or obesity.

Insulin resistance, in which cells don't take up sugar in response to the hormone insulin.